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[Gastrointestinal bleeding in children]
S Yokoyama1, J Soeda, T Fujimoto
1Department of Surgery, Tokai University, School of Medicine, Isehara, Japan.
Insights
Diagnosing pediatric gastrointestinal bleeding involves considering patient age and bleeding characteristics. Endoscopic and imaging techniques help pinpoint bleeding sources, with common causes varying by age group.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Endoscopy
- Medical Imaging
Context:
- Gastrointestinal bleeding is a significant concern in pediatric patients.
- Accurate diagnosis is crucial for effective management.
- Tokai University Hospital data provides insights into pediatric bleeding causes and diagnostics.
Purpose:
- To evaluate the site and nature of gastrointestinal bleeding lesions in pediatric patients.
- To establish differential diagnoses based on bleeding characteristics and patient age.
- To assess the utility of various diagnostic modalities for upper and lower gastrointestinal bleeding.
Summary:
- Upper endoscopy is the primary diagnostic tool for upper gastrointestinal bleeding.
- Lower gastrointestinal bleeding diagnosis utilizes sigmoidoscopy, colonoscopy, technetium scans, tagged red cell scans, and intraoperative angiography.
- Common causes include hemorrhagic disease, necrotizing enterocolitis, midgut volvulus (neonates); intussusception, internal hernia (infants); juvenile polyps, infectious diarrhea (children); duodenal ulcers, ulcerative colitis (adolescents).
- Gastro-duodenal ulcers occurred across all age groups. Indomethacin-induced bleeding caused one neonatal death, but acute ulcers were typically managed conservatively.
- Variceal bleeding secondary to portal hypertension post-Kasai procedure for biliary atresia was noted with increasing frequency.
Impact:
- Provides a diagnostic algorithm for pediatric gastrointestinal bleeding.
- Highlights age-specific etiologies of gastrointestinal bleeding in children.
- Emphasizes the importance of tailored diagnostic approaches for pediatric bleeding.
- Informs clinical practice regarding the management of various pediatric gastrointestinal bleeding causes.
- Underscores the need for vigilance regarding specific complications like indomethacin-induced bleeding and post-Kasai variceal bleeding.
Abstract:
The site and nature of lesions producing gastrointestinal bleeding was evaluated in pediatric patients admitted to Tokai University Hospital. The differential diagnosis was possible based upon the character of the bleeding and the age of the patient. Upper endoscopy is the diagnostic maneuver of choice in evaluating the upper gastrointestinal bleeders. Sigmoidoscopy, colonoscopy, technetium scans, tagged red cell scans and intraoperative angiography were helpful in locating bleeding sites of lower bleeders. Common causes of bleeding were as follows: Hemorrhagic disease, necrotizing enterocolitis, and midgut volvulus in neonates; intussusception and internal hernia in infants; juvenile polyp and infectious diarrhea in children; duodenal ulcer and ulcerative colitis in adolescents. Gastro-duodenal ulcers were found in all age groups. One neonate died of indomethacin induced bleeding, however, bleeding from acute ulcer was usually controlled by conservative treatments. Increasing frequency of variceal bleeding due to portal hypertension after successful Kasai procedure for congenital biliary atresia was emphasized.